See photos and read more about Renee’s business on the DTP Blog here. The adventures of one of her students is featured in a recent series of articles in Barbados Today.

Renee is a women’s fitness specialist, targeting all stages of a woman’s life cycle from adolescent, child bearing years, prenatal, postnatal to menopause. I design various exercise programmes to help women get into shape. As a trainer, friend and coach, I am committed to guiding, motivating and educating women to exceed their fitness goals and to permanently adopt healthy lifestyles. She started studying with DTP in March 2012 and completed the practicum in May 2012.

I most enjoy the good feeling associated with knowing that I am helping women to positively change their lives through exercise. I have learned that we are connected and not separate from each other. Sharing our challenges and triumphs enable each of us to grow and have a sense of belonging like a sisterhood. The baby and pregnancy stories always amaze me and I learn a lot considering I don’t have children of my own.  I am also fascinated by the fact that as the pregnant mummies bellies grow, they are still moving with lots of energy and I feed off of that energy.  I just love working with pregnant ladies and mothers.

Whatever the course of your labor and birth, if you are fit and prepared your ability to cope with the intensity of the experience will be a big advantage. Regular aerobic exercise, strength and mindfulness training — along with a good childbirth education course with a certified childbirth educator — pays off in the short and long run. You and your baby will benefit from endurance and long term health gains.

What I most enjoy about my work is that we are empowering women in the most vulnerable point in their life. I also love the fact that the health benefits of exercise are multiplied by two.

Our bodies are perfect machines and we are strong human beings capable of multitasking. I started doing a bulletin to nominate some “femmes extraordinaire,” and I could fit in ALL of my clients!

I am in the process of writing and reviewing the B-n-K™ Training Manual. I am also moving in the direction of franchising the B-n-K™ Methodology.

InTheBellyOfTheGoddess.com

Recognizing that Belly Dance has its origins as a Birth Dance,we seek to restore it to its rightful place in this sacred process.

My original aim was to teach belly dance to pregnant women as a tool of personal empowerment – both in the arenas of expressive creativity and for use in the labor and birth process.  My focus has evolved since I began the program.  I started with giving women what I felt was another “tool” to use to help them to cope with labor, and possibly to help them to achieve their goal of un-medicated birth, and so I taught just specific moves that I felt were useful for this purpose.  Over time, I added more aerobic movement, more “veil work” – (dancing with a silk veil), more “fun” exercises, and an end of class rest/shavasana period with either a guided meditation or affirmations.  Some of these changes that I made were a direct result of taking the DTP certification.

I love to get women into some jingly hip sashes, and get them laughing and enjoying dancing with each other.  I love to see a group come together and start bonding and exchanging info and experience.  And I love to hear how great they feel after a class – they really do shake out many of the aches and pains!

Both my clinical work as a practicing midwife, and though my belly dance business, I continue to learn how strong and capable women are.

In my clinical practice with the Brigham & Women’s Midwifery Group, many of the women we care for are socio-economically disadvantaged.  I am hoping to bring my program to these women.  Recently, I have been offering one-time mini classes in Centering Pregnancy groups, and they are always well received.

Seattle WA; Pear Press. 2010

I strongly recommend this book and its accompanying website by the author of the NY Times bestseller, Brain Rules. http://www.brainrules.net/.

The new text brings together much of the disparate research on fetal-infant-child brain development of the last few decades into a readable whole. At the same time, it associates these findings with effective, concrete practices and provides tips for new and expecting parents. What are some of the big, take-home messages of this text? Survival, or safety, is the primary goal of the brain. Happiness is most closely linked to having friends. Academic success is associated with self-control. And, rewarding effort produces the greatest positive feedback. There’s a lot more here and on the website. Plus the website has pages of references and a terrific quiz for parents. Links: Brain Rules for Baby: http://brainrules.net/brain-rules-for-baby. Brain Rules for Baby Quiz: http://brainrules.net/brain-rules-for-baby-parenting-quiz.

Dr. Medina starts with that notorious parental concern:  How do parents raise a smart, successful, calm and happy child? He considers the job of parenting to be supporting healthy brain development – something achieved largely by living a healthy and emotionally accessible life! He has the facts to back this up. Starting with pregnancy, he provides information to demonstrate that the common early pregnancy issues of tiredness and nausea serve the fetus’ need to be left alone to follow the genetic code for producing the body’s organs and systems.

The second half of pregnancy, he notes, is largely constituted by the development of the senses, which bring information to the brain, and – in the last months – the expansive growth of brain cells and the earliest phases of neuronal connection. He dispels the myths about commercial products aimed at improving IQ in utero, reviews findings on the adverse effects of stress, poor nutrition and a sedentary lifestyle during pregnancy, and reminds us that we are faced with certain peculiarities of human birth. Ever since we became erect, we have had to get that brain out of the pelvis before it is really ready.

Dr. Medina moves on to the relationship dynamics of the parents and/or extended family and its impact on the offspring brain. Most families experience distress when an infant arrives. Relationships are out of balance, demands increase, comfort is lessened and there are a lot of unknowns about the nature of this new being. Learning, he reminds us, takes place best when the number one brain demand is met: Safety. Situations fraught with stress and conflict are keenly sensed by infants and mitigate against a sense of safety.

Much of this discussion reinforces recent findings about the importance of vaginal birth, skin-to-skin contact and breastfeeding – chemical, mechanical and emotional needs that appear in the moments surrounding birth that, when met, set the stage for a bond of trust (safety) that enables development of higher functions. He reminds us that the best predictor of academic success is impulse control, a behavior that results partly from genetic predisposition, but is equally gleaned by observing adult behavior from the first moments of life. This sets the stage for much of the rest the book’s discussion using a Seed/Soil metaphor, akin to the traditional nature/nurture discussion – that some of what a child becomes is inborn, and some is environment.

Medina focuses on pregnancy through age 5. He notes that willing emotional responsiveness combined with appropriate demands or expectations appears to produce the most effective learning conditions in young children. Once they are in a safe state of mind/brain, infants learn quickly by watching [he cites Bandura]. Empathy and clear delineation of boundaries fall into line behind safety as features parents need to provide for healthy psychic development. Medina gives a number of examples, including one about empathizing with a child who needs a drink of water when there is none available by saying: Yes, how thirsty you must be and if I could, I would get you a big drink. I’m glad you let me know how thirsty you are so we can work on fixing that first chance we get. [NB: I have paraphrased here for the purpose of my own learning]. This sort of response feeds back the child’s experience, lets him/her know he/she is heard, supports the child’s state, but lets him/her know that the solution is still a bit off and that the parent expects the child to cooperate.

There are many topics covered with just this sort of technique…empathy and expectations. Among them is the description of positive and negative reinforcement. I find it is frequently difficult for parents to grasp the notion that if a child has a tantrum and the parent yells and screams and makes a big deal about it, that is positive reinforcement, which encourages the child to behave that way again. Whereas walking into another room and doing something else till the child is quiet – that is negative reinforcement.

I like Medina’s way of explaining it with science better than my own, which requires too much explaining about how nerve cells transmit information and how neural pathways become hardwired. His relies on more macro explanations (he is a developmental molecular biologist, so I really bow to him on this one). Basically, he tells us to praise behavior that is good and also to praise the absence of “bad” behavior, because praise for effort feels good. He also tells us to let the flow of events do the punishing. Either let a child continue to walk around in the snow with no shoes because s/he will figure out it hurts and is a terrible idea, or remove a child from the table when s/he refuse to eat because it is boring alone and s/he will figure out one can get hungry that way. The former is punishment by application; the latter is punishment by removal.

In case you are wondering what these rules might be, here they are:

EXERCISE | Rule #1: Exercise boosts brain power.
SURVIVAL | Rule #2: The human brain evolved, too.
WIRING | Rule #3: Every brain is wired differently.
ATTENTION | Rule #4: We don’t pay attention to boring things.
SHORT-TERM MEMORY | Rule #5: Repeat to remember.
LONG-TERM MEMORY | Rule #6: Remember to repeat.
SLEEP | Rule #7: Sleep well, think well.
STRESS | Rule #8: Stressed brains don’t learn the same way.
SENSORY INTEGRATION | Rule #9: Stimulate more of the senses.
VISION | Rule #10: Vision trumps all other senses.
GENDER | Rule #11: Male and female brains are different.
EXPLORATION | Rule #12: We are powerful and natural explorers.

NY; Bantam, 2003.

The physiology of birth is complicated and still not well understood. Our subjective experiences of birth are richly textured. Personal accounts spill over with combinations of intense sensations, strong emotions, vague impressions and fine details. What is astonishing about Ina May’s Guide to Childbirth is how exquisitely she traffics in the language of an internal landscape to describe and explain this complex process. She truly captures the uniqueness and universality of birth. I am adding this book to the list of recommendations I give my clients, as well as suggesting it to other teachers.

Devoting nearly the first third of the book to positive first-hand birth stories provides a substantial grounding. Many times I found myself thinking: Yes! That woman is describing this or that essential bit of wisdom I want to impart to my clients. Let me point out one example.

On pages 24 and 25, one of narrators describes 3 slices of her experience. First, she got advice not to read or learn too much and not to make a plan because the more details she had in mind, the less likely she would get what she wanted. Too much reading would interfere with her ability to go with her body, she was told.

Second, she describes her experience of being in a tub and how she needed a lot of reassurance because she was both scared and aware of the great power in her body. The physiological phenomena occurring in her brain and motor systems indeed would be described as these subjective states of being. She definitely perceived what was happening.

Third, she describes turning from looking at things during a contraction to listening because looking made her think, while listening allowed her to feel and be instinctive, which felt better than thinking and was not so overwhelming. Thus, she was going with her body. We see her process in this narrative.

The stories all got me thinking about whether I am telling my clients too much or too little! One of my teaching goals is to insure that clients distinguish between strategy and tactics. Example:  In the case of the story above, the strategy was to go with her body. The tactics she used were to not get too much information so she did not have too many expectations and to use sound rather than vision as her way of connecting inner and outer reality.

As a teacher, I see my job as insuring that my clients who might hear this story do not think that they must use sound rather than vision in order to go with their bodies, but rather that this was a piece of the process for this woman to reach her objective. It might work, but it might not. To get this across to clients, I tell stories about births in which I have been present when opposite tactics accomplished the same strategy or where the same tactic led to different outcomes.

The multitude of stories she presents in part I allow part II – the textbook part – to come to life. Whether she is discussing stages of labor, pain or release, she calls up stories and because the reader is already receptive to the notion of examples, the illustrations help the reader grasp whatever point she is making about the process.

However, the complex physiologic sequence of birth, including its variation from woman to woman, is less well served – in part because there is still so much to be learned about how birth happens, and in part because the birth community in general (whether having had professional or academic training) is not as well versed in normal physiology as it could be.

Let me focus on two issues: One is pain/pleasure and the other is hormones/behavior. Regarding pain/pleasure, Ina May makes a lot of important points, among them that how we experience an intensely sensational experience depends to a great degree on our preparation and that different women have different pain/pleasure experiences during birth. What she doesn’t tell us, though (and I suspect because it’s not common knowledge), is that some of the factors that control how we experience sensations are beyond our control. We experience pain/pleasure through a series of sensations, mental foci and behaviors such as breathing and muscle release. These nerve impulses are forwarded throughout the brain, some sensations taking on emotional content – some terrifying and others ecstatic – depending on the neural pattern. This is the basis of both the fear/tension/pain syndrome and the orgasmic pattern. But the precise pattern is dependent on genetics, as well as environment and behavioral training.

Some individuals become aware of sensations at a very low neurological threshold; others do not. Some individuals quickly find sensation of which they are aware to be uncomfortable or emotionally intolerable; others do not. Some people need comfort measures for their discomfort soon; some later, or not at all. Tolerance of what finally becomes pain or pleasure (or just a sense of stretching or motion through space) is also variable from person to person. Thus, the point at which we start has both biological and psychosocial determinants within this already variable process. In describing the variation in how women experience pain and pleasure in labor, Ina May is great at giving us examples and identifying psychosocial or cultural variations identified in research, but not so enlightening on the biology of why and how. This may or may not matter to the reader.

The issue of hormones that govern the vicious cycle we call labor is much less well understood. We have a pretty good concept of how prostaglandins, oxytocin and endorphins are stimulated and affect the process, and Ina May describes these in accessible ways. But while adrenaline is thought to inhibit early release of oxytocin, there has been little discussion of its importance in the pushing or ejection phase (she does cite Michel Odent’s notion that adrenaline might play a part in the ejection reflex when a labor is slowing down). But, there is little recognition outside of the physiology field that what happens in transition is our energy system shifting to a sympathetic [adrenal] source to give us more power to push. That’s why contractions change, why some women have a rest period between, and why – back in the day – we used to say to a woman having difficulty culling up her resources to push that she could get mad! Going through the effort and discomfort is key to inducing the rush of beta-endorphins. We know this, in a scientific way, from research that tells us runners who listen to music (relaxing and dissociative) experience lower rates of beta-endorphins at the end of the run than runners who do not listen to music, but work through the effort and discomfort they experience (stress inducing).

One of the things that makes Ina May’s book so valuable, in my mind, is the discussion near the end about midwifery, statistical support for natural birth and enumeration of the risks associated with surgical birth that are often glossed over when a family experiences dystocia. There are many elements within the birthing community striving to create an accessible spectrum of choices for birth. Let’s face it, birthing at home for low risk women, seamless transport alternatives, birthing centers attached to medical facilities, and readily available medical options when emergencies arise, would be a wonderful future. Birth attendants with universal acceptance, variable but rigorous training, and delineated scopes of practice would be ideal. Whether we get there remains to be seen, but I am glad Ina May exists, has her track record and is being listened to in this effort.

I have long wanted to write this post. Recently two articles appeared in the NY Times prompting me to move forward. One article dealt with how it is that ongoing vigorous exercise produces brain enhancements. The second article dealt with how running creates its “high” and explained why the resulting addiction is an evolutionary benefit for human survival.

Every day in Africa a gazelle wakes up.

It knows it must run faster than the fastest lion or it will be killed.

Every morning a lion wakes up.

It knows that it must outrun the slowest gazelle or it will starve to death.

It doesn’t matter whether you are a lion or a gazelle.

When the sun comes up, you better be running.

Abe Gubegna
Ethiopia, circa 1974

The pregnant mom who exercises vigorously and regularly — the one who runs or swims or does aerobic dancing — is not the one at risk, or whose infant is at risk, of a lack of tolerance for the rigors of labor or for lifestyle health problems. It is the sedentary or low activity mother and her offspring who are at risk. I have written at length on this reality in my chapter on Women and Exercise in Varney’s Midwifery.

This realization has plagued me for ages, and the two articles in the Times convinced me to make this statement, explain why it is true and exhort women of childbearing age to become aerobic animals.

In the contemporary world, we are not as active as previous generations. Few women exercise to the extent required to develop the capacity to withstand the rigors of birth. It is little wonder that so often health care providers hear that women are afraid to exercise, and childbirth educators hear that pregnant moms are afraid of birth and don’t have confidence in their ability to do it. There are solutions for these issues…

The biggest bang for the buck is aerobics. This gets almost everything that helps you in labor. It increases endurance, strength and range of motion. It improves breathing capacity (you get more oxygen + less fatigue). It reduces your need to tap your cardiac reserve (your body works hard in labor but not to the degree it must if you are not fit). Plus, regular participation in a good cardio or aerobic workout gives you the mental toughness and confidence you need to know that your body is capable of the work and the recovery — what we call body trust. Fit Pregnancy has discussed the myths surrounding how hard a pregnant woman can work out.

Learning useful positions and movements is extremely helpful. Be sure that your workout also includes strength and coordination movements — such things as squatting, core movements for pelvis and spine, and other motions that aid your progress in labor. Being upright and moving are keys to a healthy labor. These require strength and coordination.

Mental focus and being present teach you to work with your body. Activities such as relaxation training, yoga, pilates for pregnancy and dance help you develop the mental skills (mindfulness and deep breathing) that accompany your movement. Learn to recognize your body’s signals so you know when it’s time to push.

A truly effective use of your time is a one hour class a couple times a week that combines all these elements. We have known this for decades. The evidence is clear that it works. Keep moving…right into labor and birth!

Find a safe and effective class or trainer.

Lamaze International, Childbirth Education Training - Lamaze CBE trainings

Summer 2013 TBD: Dancing Thru Pregnancy Teacher Practicum, New Haven CT. For who pass the correspondence Study Course by May 15, 2013 and those who are renewing their certification. Information: director@dancingthrupregnancy.com

May 29-June 2: American College of Nurse-Midwives ACNM 58th annual meeting, Nashville TN. Premier sessions address topics of broad significance and feature nationally-recognized advocates for maternal health. Workshops address clinical practice, and the meeting offers a comprehensive education program with seven defined tracks addressing our profession’s critical concerns. Social and networking events provide the backdrop for our community of midwives and maternal health professionals.

June 20: American Academy of Birth Centers - Practical Techniques to Support Women in Childbirth Workshop, Irvine, CA.

Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.

On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?

But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?

How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals.  There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]

But, what about all the things we don’t know about?

If these goats eat the wrong grass, will they go into labor?

Here is a cautionary tale:  There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!

What are the take-home messages here?

• Probably no one is ever a perfect fetus…too many possible threats.
• There are some threats we can avoid…being lazy, over-eating, smoking.
• There are some threats we cannot avoid, so we do the best we can.

Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.